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General NPI Number Information
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NPI Number | 1265656227
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Entity Type | Organization
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Legal Business Name | INSTITUTE OF FACIAL SURGERY
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 04/20/2008
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Provider Practice Location Address
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Address Line | 5929 FASHION BLVD
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City | MURRAY
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State | UT
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Zip | 84107-7364
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Country | US
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Telephone | 801-261-3637
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Fax | 801-261-4096
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Provider Business Mailing Address
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Address Line | 5929 FASHION BLVD
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City | MURRAY
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State | UT
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Zip | 84107-7364
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Country | US
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Telephone | 801-261-3637
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Fax | 801-261-4096
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Authorized Official
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Title or Position | DIRECTOR
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Name | DR. BRENT D KENNEDY
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Credential | M.D.
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Telephone | 801-261-3637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical
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License Number | 2001ASF0602
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License Number State | UT
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